CNS nutrition - Parks

Question 1

Diet may have a positive effect on what disease?

Answer 1

Alzheimer’s. Studies have shown that B vitamin treatment slowed shrinkage of the brain.

Question 2

Vitamin B1 is called what?

Answer 2

Thiamine

Question 3

What is a disease of thiamine deficiency?

Answer 3

Beri Beri

Question 4

What diseases is associated with Thiamine deficiency and CNS effects?

Answer 4

Wernickes’s and Wernicke-Korsakoff syndrome.

Question 5

What does Wernicke’s encephalopathy cause?

Answer 5

1. ophthalmoplegia - affects eye muscles
2. cerebellar ataxia
3. mental impairment - confused, disoriented, indifferent

Question 6

What is the pathology of Wernicke’s encephalopathy?

Answer 6

Foci of hemorrhage and necrosis in the maxillary bodies (also increased vascularity and edema) and walls of the 3rd and 4th ventricles and the thalamic nuclei.

Question 7

Wernicke’s Korsakoff causes what?

Answer 7

Memory of new events is seriously impaired so these patients may confabulate.

Question 8

Does Wernicke’s Korsakoff affect older memories?

Answer 8

No.

Question 9

What is the pathology of Wernicke’s Korsakoff syndrome?

Answer 9

Similar to Wernicke’s encephalopathy but there may be prominent degeneration of the neurons the walls of the 4th ventricle and medial thalamic nuclei.

Question 10

Thiamine deficiency produces what?

Answer 10

A diffuse decrease in cerebral glucose utilization that results in mitochondrial damage.

Question 11

What is the difference between Wernicke’s encephalopathy and Wernicke’s Korsakoff syndrome?

Answer 11

Wernicke’s Korsakoff syndrome is chronic Thiamine deficiency (clinical term because it requires the confabulation and memory problems) and Wernicke’s encephalopathy is acute.

Question 12

What is one function of the maxillary bodies?

Answer 12

Memory.

Question 13

What patient’s are at risk for Wernicke’s encephalopathy?

Answer 13

1. Chronic alcoholics- poor diet
2. chronic gastritis
3. gastric carcinoma
4. persistent emesis
5. gastric bypass
6. prisoner’s who are fed a poor diet

Question 14

How does alcohol affect Thiamine?

Answer 14

It directly impairs the absorption of thiamine.

Question 15

What is the treatment for Wernicke’s?

Answer 15

Parenteral Thiamine - IM or IV.

Question 16

How is Wernicke’s diagnosed?

Answer 16

Clinical picture plus X-ray with contrast to look at maxillary bodies.

Question 17

What is parasthesia?

Answer 17

Painful, tingles and numbness type feeling.

Question 18

What is the normal value for serum methylmalonic acid?

Answer 18

Less than 400 nmol/Liter.

Question 19

If a patient has impaired positional and vibrational sense?

Answer 19

The posterior columns of the spinal column.

Question 20

What is the normal value for serum homocysteine?

Answer 20

Less than 14 umol/L.

Question 21

What does B12 deficiency cause?

Answer 21

Reversible (if treated early) bone marrow failure and demyelination of the CNS neurons.

Question 22

B12 deficiency can cause what?

Answer 22

Combined demyelination and degeneration of neurons in the dorsal and lateral columns of the spinal cord.

Question 23

WHat is necessary for B12 absorption?

Answer 23

Intrinsic factor.

Question 24

What can Crohn’s disease cause?

Answer 24

Lack of absorption of B12 and intrinsic factor.

Question 25

What conditions can cause B12 deficiency?

Answer 25

1. pernicious anemia - ie. atrophic gastritis
2. gastrectomy - possibly due to cancer of stomach, ulcers etc.
3. impaired malabsorption from intestines
4. bariatric surgery - ie. laparoscopic sleeve gastrectomy
5. inadequate diet or vegetarianism

Question 26

Where is intrinsic factor secreted?

Answer 26

Parietal cells in the funds of the stomach.

Question 27

What symptoms can vitamin B12 deficiency cause?

Answer 27

Myelopathy, neuropathy, dementia and depression.